A Case of Sigmoid Colon Ischemic Colitis of the Necrotizing Type Occurring After Abdominoperineal Resection (APR) Via the Retroperitoneal Route

Abstract

A man in his 80’s was diagnosed as having lower rectal cancer, and abdominoperineal resection (APR) with sigmoid colon colostomy was performed via a retroperitoneal approach. Multiple metastatic tumors were identified in the liver, and chemotherapy was administered with the FOLFIRI regimen postoperatively. Twenty months after the surgery, the patient was admitted to our hospital with left lower abdominal pain. Twelve hours after his hospital admission, bleeding was observed from his colostomy. Emergent colonoscopy revealed sigmoid colon necrosis with mucosal shedding in a 3-cm segment proximal to the colostomy. We diagnosed the condition as ischemic colitis of the necrotizing type, and emergency operation was performed. We resected the necrotic portion of the colon, including the colostomy, and constructed a new colostomy. In this case, we considered that one of the important risk factors for the ischemic colitis was blood flow disturbance due to resection of the sigmoid colon via the retroperitoneal route, with poor extensibility, in addition to other risk factors in the patient, such as advanced age, hypertension, chemotherapy for tumor metastasis.